OASIS Alert

Prepare for the perfect storm, a SNF quality improvement survivor warns.

The government's home health quality initiative has a multitude of purposes but opinions differ about how realistic they are.

The Centers for Medicare & Medicaid Services' focus on quality is not going away, because it's one way for the agency to leverage its regulatory and purchasing power into improved patient care, explained Dr. Barbara Paul, CMS' director of the Quality Measurement and Health Assessment Group, speaking at the National Association for Home Care & Hospice's annual policy conference in Washington April 9. CMS' efforts to establish and enforce standards "only move quality so far," leaving much room for improvement, Paul reminded attendees.

Phase 1 of Home Health Compare includes publicity events in each of the eight pilot states, ads in newspapers, and new scripts for those who answer 1-800-MEDICARE to respond to questions from consumers without Internet access, Paul said. CMS is aware of the errors in the demographic information on the Web site (see story 2 ), Paul admitted, but entering changes will take time.

While the outcomes being used in the pilot program will be used for the national rollout in the fall, experts say they aren't set in stone. After "at least a year" of experience with the outcome-based quality improvement measures in Phase 1, the outcome measures could change. The National Quality Forum will consider whether these measures "are appropriate to consider 'standards,'" or whether CMS should use other OBQI measures, Paul explained.

CMS believes "if you can measure it, you can improve it," Paul added. The combination of focusing on a measurement and providing technical assistance has proven to be very effective in improving quality, she reminded attendees. And installing systems that are blind to socioeconomic status also helps reduce health care disparities, she suggested.

But "the perfect storm" is brewing, predicted Dr. Charles Roadman, president of the Washington-based American Health Care Association, speaking in the same session. The ideological fight about who is responsible for health care and shrinking government budgets will impact providers, as payors tell providers "we want better quality and we're going to give you less money," Roadman suggested.

Although Roadman applauds CMS' quality initiative as extremely important, he believes quality will "have to decrease based on budget." Health care really depends on the government's budget, not on market forces, Roadman contended. And "quality is directly linked to staffing, which is directly linked to sustainable funding," he added.

After looking at the effect of the quality initiative on skilled nursing facilities, Roadman had some suggestions for home health agencies beginning the QI journey: